Dazeland

Andrew Scull

Most recent work on the history of psychiatry has tended to focus on the history of institutions, of ideas, and of the psychiatric profession itself, and to ignore those for whom this vast infrastructure has (at least ostensibly) been erected. It is a historiography, as David Ingleby wittily put it, ‘like the histories of colonial wars’: it tells ‘us more about the relations between the imperial powers than about the “third world” of the mental patients themselves’. For this reason, among many others, Elaine Showalter’s The Female Malady is to be welcomed, for its primary focus is upon this neglected group – for the most part, on female patients.

Her account makes it plain that in the psychiatric domain, as in the conventionally-defined Third World, the position and treatment of women consistently turn out to be even less enviable than those endured by men. Can this, however, justify a move to label madness ‘the female malady’? Not, surely (and contrary to what Showalter sometimes seems to suggest), in any straightforward statistical fashion. One may plausibly contend that, for much of the past two or three centuries, women have outnumbered men in the ranks of the mentally disturbed. Still, for the most part, this has not been in such gross disproportion that one could sensibly call the disorder a pre-eminently feminine one; and there have even been occasions when men have constituted a substantial majority of those officially identified as mad.

For example, against the fact that nearly two-thirds of those who consulted the 17th-century astrological physician Richard Napier for treatment of their mopish or melancholic moods were women, one must set the observation that, as best one can judge from the admittedly defective data, men greatly outnumbered women among the inmates of 18th and early 19th-century madhouses. It was only after the middle of the 19th century, when the madhouses of the Gothic novelists had supposedly been transformed into the domestic retreats favoured by the Victorian lunacy reformers, that women began gradually to outnumber men among those legally designated as mad – first among the pauper residuum who contributed the bulk of the rapid rise in the ranks of mad folk, and not till the end of the century among their genteel and affluent cousins. Nor, among the institutionalised insane, did the imbalance ever amount to more than a few per cent, and this itself was quite possibly attributable to the greater longevity of the ‘weaker’ sex and to the disposition of the asylum authorities to keep female lunatics institutionalised longer than their male counterparts. And from the late 1960s to the present, men have formed the clear majority of mental hospital populations in the United States, while the best modern research can find no consistent differences by sex in the prevalence of psychotic symptoms or in rates of schizophrenic breakdown.

It would perhaps be more supportable to suggest, on a more expansive view of what constitutes mental illness, that women are more frequently troubled in mind. If women were only marginally over-represented among the ‘Bedlam mad’, the rise of a non-asylum psychiatry, ministering to the neurotic, the neurasthenic and the hysteric, quickly found itself catering to a more heavily female clientele. On the late 19th-century borderlands of insanity, women were disproportionately represented among the clientele of rest homes, water-cure establishments, Mesmeric salons, and the mind cures of the Christian Scientists. And in the present, women are found to be more prone to neurosis and manic depressive symptoms, and are much more likely to be taking psychoactive drugs.

Yet these figures, too, demand to be treated with some caution. For alongside the greater reported frequency of symptoms of mental illness among women, and their more extensive utilisation of psychiatric facilities, one must note that an identical pattern holds for physical illness and the use of non-psychiatric physicians and hospital services. Puzzlingly, women exhibit higher rates of morbidity and lower rates of mortality than men of comparable age and social circumstances.

Still, if the statistical evidence is at best rather ambiguous, the assertion that our culture views the female of the species as more prone to irrationality and mental imbalance is not without foundation; and our organised responses to these maladies repeatedly turn out to be influenced, in ways both gross and subtle, by questions of sexuality and gender. One appreciates, then, an attempt to explore what is distinctive about the female experience of madness. Drawing upon an extraordinary array of sources (literary and pictorial representations of the mad, in painting, photography and film; asylum records; the recollections of ex-patients; the words and practices of their physicians; and the private papers of eminent women who did not become psychiatric casualties – materials which provide eloquent testimony about the tensions and tribulations faced even by exceptionally talented and apparently successful women trapped within the confines of a patriarchal social order), Elaine Showalter has constructed a powerful (and only occasionally overdrawn) portrait of the contributions of psychiatry to the wrongs of women.

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